Guide for congenital cataract surgery in children

What is congenital cataract? 

A cataract is any light scatterings opacity of the lens. It is estimated that congenital cataracts are responsible for 5% to 20% of blindness in children worldwide. Incidence varies from country to country. 

Your child might have been born with a cataract. Your doctor may use the word “congenital.” It means that the eye lens did not form properly during the pregnancy.

Sometime cataract  can occur by a genetic issue like Down syndrome. They could likewise be innate, meaning a child’s mother or father might have them. Or on the other hand, your kid could develop them after birth. There are numerous potential causes, including:

• Eye injury
• Diabetes
• Complications from eye problems
• Radiation treatment
• Steroids

When your child needs cataract surgery 

Whether or not your child needs cataract surgery is totally depend on whether their vision is affected or not. Thus, cataracts should be evaluated and treated promptly. After the first months of life, the development of vision slowly becomes less time sensitive. The ideal time for removing cataracts in a newborn child is often urgent, however in a 1-year-old it is more routine, and very selective in a school-age kid.

Symptoms of cataracts can vary from child to child, but may include:

• Decreased vision in the affected eye.
• Whitening or clouding of the lens.
• A white or dark pupil reflex on photographs.
• Light sensitivity.
• Holding items close to the eyes to see them.
• If your kid face above symptoms than it is essential to have your kid’s vision checked regularly. The earlier you find cataracts, the better their vision will be in the long term. 
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Is my child ready for surgery?

Caring for your family and child involves numerous ups and downs. Having a child who has surgery can be extremely stressful and understanding what to expect can help. The following are some recommendations for preparing your child for surgery. 

Prepare yourself first

You cannot prepare your child for eye surgery until you have prepared yourself. 

Once you’ve educated yourself, addressed any existing myths, and calmed your own worries, you’ll be able to provide your child a better understanding of what will happen and why it’s important. 

Let them know what to expect

Use simple, comforting language to explain why your child is having eye surgery. Choosing your words properly is a simple method to assist them overcome their worries.

Pre surgery visit to eye specialist 

Before your child surgery day, you’ll meet with your kid ophthalmologist for a thorough eye exam. As part of this exam, your ophthalmologist will:
Check your child’s eye condition.

• Check for symptoms that your child should not have surgery.
• Identify risk factors that may complicate your child’s operation.
• Measure your child’s eye to determine the appropriate focusing power for their IOL (a lens that is placed in the eye)
•  Inform you whether your child needs prescription eye drops.

Parents should discuss any concerns or questions with their child’s ophthalmologist. Consider asking

• What are the benefits? 

• What type of IOL do you recommend to my child?
• Will my child need glass or contacts after the surgery?
• How long will my child recovery be?

From here, your doctor has some options: 

• Artificial lens (still being investigated for use in very young children)
• Contact lenses
• Eyeglasses (most children need them even after successful surgery)

What can be expected on the day of surgery? 

As a parent, you should arrive at the hospital on schedule. Upon arrival at the hospital or surgery center, the patient and family may meet with the doctor and nursing staff to discuss the patient’s history. Doctors and staff will do some tests and administer medicines to determine if your kid is eligible for surgery.

 Your doctor will give your youngster general sedation or anesthesia, so they will not be conscious or feel anything during the surgery. They will use special devices to separate the focal point, then eliminate it through a tiny cut. It will not take much time.

• Your physical presence close to your child on the day of surgery will comfort them that everything will be well.
• Confidently speak with your youngster to help them feel comfortable.
• To put your kid to sleep, the doctor will prescribe a local anesthetic, which is a medicine to keep them sedated.

The doctor will remove the cataract from your child’s eye.  Surgical technique is dependent on the age of the child. The lens can almost always be aspirated or removed with a vitrectomy cutter 

The process takes approximately 15-30 minutes to perform, depending on if there are any issues. Surgical procedures typically take two to three hours from arrival to departure.
Complications are uncommon and typically manageable. In a tiny minority of instances, further surgery may be required.

Sometimes, if your child has cataracts in both eyes — or one was worse than the other — they may develop a condition called amblyopia. It happens when one eye is stronger than the other and can be treated by their doctor.

Your kid will be continuously observed in the nursing unit after surgery.

• Your youngster will be urged to consume fluids orally. Your youngster will begin with sips of clear fluids (transparent liquids), ice chips, or freezes. Once your child can take sips, they can start drinking liquids from a cup.
• Your child’s temperature will be monitored routinely. 
• Your kid may get pain medication as required.
• The nursing team will monitor your child for vomiting or bleeding.
• Nurses will notify doctors if issues arise.  

What Happens After Surgery?

 If your kid experiences discomfort following the procedure, they will be given pain medication as a liquid to drink.

• Your child should have relatively little discomfort following the procedure.
• In 90% cases your kid might be allowed to return home on the same day.

• Very young children get over this surgery quickly and usually are back to normal in about a day. Older kids might be a little uncomfortable for a few days, mostly because their eyes may be itchy or scratchy.
• It would be best if you took your child home in a vehicle or taxi. Avoid taking your youngster home by bus or tube for their comfort and safety.

• If they had a cataract removed from just one eye, they may have to wear a patch on the other. That’ll help to strengthen the eye that was operated on.
• How long they’ll have to wear the patch depends on a lot of different things that your doctor will discuss with you.
• Your doctor will send you home with prescription eyedrops and directions on how to give them to your child. Eyedrop use in children presents specific challenges. Any young child on long-term topical corticosteroids should be referred to pediatric endocrinology for assessment of adrenal suppression. 
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What post-surgery care is needed at home?

Following cataract surgery, if your child has been operated under topical anesthesia, surgeon will directly prescribe post-operative dark glasses, or if your kid has undergone surgery under local anesthesia than he will have an eye pad and plastic shield over the eye. Eye pad is usually removed 2 hours after the surgery at the hospital. Before you leave the hospital, your child ophthalmologist will prescribe some eye drops and other medication to reduce inflammation, 

Dos and Don’ts or precautions after cataract surgery

Don’ts:

• Prevent your child from rubbing their eyes with hands, it can cause eye infections. If their eye itches, you can wipe it gently with a clean tissue or a sterile, moist cotton swab.
• Do not let your child have a shower bath for the first 10 days after surgery. Your child can take a bath below the chin only and use a wet towel to wipe face.
  • Eye washing with normal water is not allowed for 10 days. 
• Prevent your child from participating in activities that might cause damage to your eyes.

Do’s:

• Your child can resume activities like watching TV after 2-3 days of surgery. 
• Put eye drops regularly, as advised by your eye doctor.
  • Do wash your hands with soap and water before applying any eye medications to your child. 
• Your child should wear a protective eye cap at night for a week.
•  Clean your child eyes with clean boiled water using cotton, 2-3 times a day.

Will My Child Be, OK?

Treating your child’s cataracts early on can help save their vision.

It’s also very important to keep all appointments after their surgery. That way your doctor can make sure they’re healing properly and can see the world clearly — not just now, but well into adulthood.

When to seek immediate medical care?

• Your child has eye pain.
• Your child has pus draining from his eye.
• Your child vision gets worse.
• Your child eye is still red and bloodshot after 3 or 4 days of surgery.
• If Your child notices new floaters, flashes of light, or changes in vision.